Insulin

Medicare Part B (Medical Insurance)

 doesn’t cover these:

  • Insulin (unless use of an insulin pump is medically necessary )
  • Insulin pens
  • Syringes
  • Needles
  • Alcohol swabs
  • Gauze
Your costs in Original Medicare

You pay 100% for insulin (unless used with an insulin pump, then you pay 20% of the 

Medicare-Approved Amount

 after you meet the Part B

deductible [glossary]

). You pay 100% for syringes, needles, alcohol swabs, and gauze, unless you have Part D. 

Insulin savings through the Part D Senior Savings Model

You may be able to get Medicare drug coverage that gives supplemental benefits specifically for insulin. You can get this savings on insulin if you join a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. Participating plans offer coverage choices that include multiple types of insulin at a maximum

copayment

 of $35 for a month's supply. (The $35 maximum copayment doesn't apply during the catastrophic coverage phase of Medicare drug coverage.)

Note for people with Extra Help

If you get full Extra Help, your set copayment for insulin is lower than the $35 copayment for a month's supply under the Senior Savings Model. If you get partial Extra Help in 2022, you may pay up to a $99 deductible and 15% coinsurance, which may be higher or lower than the $35 copayment under the model. Contact 1-800-MEDICARE if you need help checking the level of Extra Help you get.

note:

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • If your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service
Things to know

Part D covers these:

  • Injectable insulin that's not used with an insulin pump
  • Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs

However, if you use an external insulin pump, Part B may cover insulin used with the pump and the pump itself as durable medical equipment (DME). If you live in certain areas of the country, you may have to use specific pump suppliers for Medicare to pay for an insulin pump.

note:

Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn’t cover - like vision, hearing, or dental. Contact the plan for more information.

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